| Objective:(1) To compare the efficacy of two forms for vaginal administration which are Utrogestan and Crinone 8% for luteal phase support in assisted reproduction cycles in Systematic Reviews and Meta-analysis.(2) A prospective, randomized study was used to compare the clinical effects of two programs of Crinone 8%, Utrogest and oral dydrogesterone which were accepted for luteal phase support in ART cycles.Methods:(1) This part of study used Systematic Reviews and Meta-analysis to compare the efficacy of two forms for vaginal administration which are Utrogestan and Crinone 8% for luteal phase support in in vitro fertilization and intracytoplasmic sperm injection. All relevant randomized controlled trials until February 2016 were screened. Patients for randomized controlled trials were met the standards which were undergoing embryo transfer in IVF/ICSI cycles, less than 40 years of age, approved by the local hospital ethics audit, no limits of numbers of IVF/ICSI cycles and programs of COH. The outcomes for evaluation were clinical pregnancy rates, implantation rates, early miscarriage rates, ectopic pregnancy rates and so on.(2) A total of 100 patients who accepted the long program of COH in IVF/ICSI-ET treatment in the first hospital of Lan Zhou University during 2015.08.01-2016.02.01 were selected. According to the different luteal phase supports, they were divided into Crinone 8% group(group A) 50 cases(cycle) and Ustrogest joint with oral dydrogesterone group(group B) 50 cases(cycle) according to the randomized principles. Recording and comparing the basic information, results related to luteal phase supprot, the clinical data of IVF/ICSI-ET assisted reproduction treatments and outcomes.Results:(1) There were totally 6 randomized controlled trials screened in this Systematic Reviews and Meta-analysis in the end. All the 6 trials had no significant difference in age, follicle number, Gn dose and days, oocyte number, the high quality rate of embryo, abortion rate and other basic measures. Among these measures, 6 trials had compared the difference of numbers of oocyte. The number of embyo transfers and clinical pregnancy rate were compared in 5 trials. 4 trials had recorded the change of early miscarriage rate, whereas 3 trials compared the difference of high quality number and fertilization rate. At last, 2 trials recorded the endometrial thickness on the day of h CG and rate of implantation.(2) There were no significant difference observed in early abortion rate and ectopic pregnancy rate between two groups(p > 0.05). Compared with Ustrogest group, the Crinone group showed higher rate of clinical pregnancy and implantation(p < 0.05).(3) No significant difference of basiclines like age, years of infertility, BMI and basic hormones had been found in the prospective, randomized study(p > 0.05).(4) Compared with the combination group, the Crinone 8% group showed similar clinical pregnancy rate, early abortion rate, multiple pregnancy rate and ongoing pregnancy rate(p > 0.05).(5) Compared with the combination group, using Crinone showed higher vaginal bleeding rate before 14 days after embryo transfer.(p < 0.05).Conclusion:(1) Retrospect secondary analysis of randomized controlled trials showed that Crinone had significant clinical effect when used for luteal phase support in IVF/ICSI cycle than Ustrogest.(2) When choosing the long program COH for IVF/ICSI-ET, the clinical results were similar either using Crinone 90 mg everyday or Ustrogest 600 mg with oral dydrogesterone 40 mg everyday.(3) Part of patients may have vaginal bleeding symptoms before 14 days after embryo transfer. Howerver, the bleeding symptom had noting to do with last clinical outcomes. Doctors could add low dose of estradiol to reduce the psychological stress in patients.(4) It is necessary to use Crinone widely in assisted reproduction cycles which has numerous advantages like high bioavailability, few side effects and convenient delivery. |
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